Patient profiling is part of the medical school curriculum

I recently read an article entitled, “Are you a victim of patient profiling?” and it got me thinking about my medical school career thus far, particularly my recent preparations for USMLE step 1.

Patient profiling is part of medical school curriculum. Many of the practice questions that I’ve done for Step 1 have relied on patient profiling (a euphemism for prejudice I believe) to get the correct answer. If the question starts out with, “The patient is a 35-year-old African-American female,” a list of diseases already begins to populate in my mind: sickle cell anemia, sarcoidosis, and fibroids all come to mind in the first seconds, and I don’t even know her symptoms yet.

If you were to change the question to ,“The patient is a 35 year old Asian-American female,” my mental list of prejudiced diagnoses changes drastically: Takayasu’s arteritis or alpha-thalassemia.

How can one possibly expect that these types of snap judgments that we are taught to make during the first 2 years of medical school, and are thoroughly reinforced during weeks on end of studying for a board exam, will suddenly go away? How can we be expected to keep an open mind, and consider all of the diagnostic possibilities if we are trained to jump to conclusions based on such a meager amount of information?

Please don’t misunderstand me; it is true that certain groups of individuals are disproportionately affected by certain illnesses. Having knowledge of these differences is a good thing, because it can help to bring relevant diseases to one’s mind. However when that knowledge gets in the way of listening to the patient, and understanding that individual patient’s story we can run into trouble. Indeed, we could really harm our patients (I seem to recall reciting some oath to the effect that we’re not supposed to do that) if our judgment is too clouded to hear them out. Medicine is not one-size-fits-all.

Of course, it is easy for me, as someone who has yet to enter the clinical phase of my training, to get up on my high horse about such things. I’ve not yet been in the trenches of clinical medicine. I am far from perfect; there are plenty of people who would tell you so. I too will inadvertently wield medical prejudice as a tool to attempt to make quick work of my patients.

I believe that prejudice is a part of the human condition, no matter how much we may like to believe that it is not. We all make snap judgments. What we can do is struggle against it, but the first step is to acknowledge that we prejudge. From there, we can try to keep vigilant, and remind ourselves to keep an open mind when we feel that snap judgment coming. We must make a concerted effort to grow in this area, not only as a medical community, but also as human beings.

Patient profiling is part of the medical school curriculum 11 comments

It is somewhat encouraging to see med students thinking about these things, and I can only hope that these thoughts will not be stifled by years of hard work and mounting debt, because it is going to get worse. If the IOM has its way, the questions are going to go something like this: “The patient is a 35-year-old unemployed African-American transgender female of the Islamic religion with a hostile personality and history of incarceration….” and we do this in order to reduce disparities……

ninguem

“Caucasian” encompasses Europe, the Middle East, to South Asia and India.

When we “profile” a European white, we will specify Nordic or Southern European ancestry. We discuss diseases found in Ashkenazi Jews versus Sephardic.

Luckily, the IOM is also proposing to also add “country of origin” to standard demographics, so this should be addressed… there will be a rich menu of options to treat, discriminate, triage, report, monitor, apprehend at a very granular level….

ninguem

Remember the movie “Mask”, with Cher?

She had a son with a craniofacial anomaly, the kid was very intelligent, but had a startling appearance becaose of the craniofacial anomaly. She tried to enroll the kid in a school, and the principal did not want to accept the kid, because he had “special needs”. Cher’s response to the principal was like this.

“Does your school offer math? English? Science? Geography? History? Those are his needs.”

We may go too far, and the multiculturalism becomes “profiling”.

Eric Strong

Thanks for this post. This is an underappreciated problem in medical education. As you indicated, there are a few diseases that have very uneven distributions among genders or different ethnic groups. However, the majority of disease-gender or disease-ethnicity correlations that are reinforced in class, on wards, and during test prep, are not nearly as strong as is commonly believed or commonly assumed. I personally think the greatest source of this problem is test-prep books that attempt to distill a disease down to 10 easy to remember bullet points. Another source of this problem is the deeply flawed concept of illness scripts, which are now taught in many medical schools. This is a significant source of diagnostic bias.

Yes, always best to keep an open mind when working with patients. Look at the world through their lenses. Step into their shoes. Do unto others as you would like them to do unto you. Don’t judge a book by its cover. Life encompasses so much more than one can learn on a multiple choice test.

Karen Ronk

I hope you are still looking at things this way in 10 years. If so, your patients will be fortunate.

iphone12

Hi, patients with past and current psych med histories definitely feel like they are being profiled to the detriment of receiving good medical care. Many of us have decided not to disclose our history with new physicians out of fear that will impact our treatment based on our previous experiences.

One person on a board in this situation was able to get the doctor fortunately to take her seriously and it turned to be quite serious. But she said the doctor admitted initially attributing her symptoms to anxiety which I found scary. And many doctors wouldn’t have done more testing and would have stopped there because of that “evil” mental illness label.

Personally, I hate not being able to be completely honest with my doctor but my experience has proven that sadly honestly, doesn’t always pay.

I would love hearing comments on this situation because it is a big time problem that I feel most doctors don’t take seriously.

HJ

I do not discuss any mental health issues with doctors. I only seek the help of a doctor if I have measurable symptoms.

I also had a condition that was wrongly attributed to depression and once I stopped discussing my past history with depression, I got the treatment I needed.